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Who am I? That is a question the rest of you could probably answer better than I. I am a wife, mother, daughter, sister, friend, pediatric nurse practitioner, cook, teacher, gardener, lover of words and music, occasional seamstress, and homemaker. I do have a couple of talents of questionable merit: I can create a decent meal in less than 30 minutes. I can feed and/or soothe almost any baby. And I can remember practically any song I've ever heard. For the rest, I'd rather those who know me decide.

Wednesday, April 13, 2016

Combining nivolumab (Opdivo) with radiation therapy may
provide better disease control and prolong overall survival in patients with
melanoma whose disease has metastasized to the brain, compared with standard
current treatment....according to new report from onclive.....

Combining
nivolumab (Opdivo) with radiation therapy may provide better disease control
and prolong overall survival (OS) in patients with melanoma whose disease has
metastasized to the brain, compared with standard current treatment, according
to a recent retrospective analysis.

According to study results, Kaplan-Meier estimates for local brain metastases
control following radiation were 91% after 6 months and 85% after 12 months.
Median OS from the date of stereotactic radiation and nivolumab initiation was
11.8 and 12.0 months, respectively, in patients receiving nivolumab for
unresected disease. Median OS was not reached in patients treated in the
resected setting.

“This is the first study to assess outcomes of nivolumab and stereotactic
radiation for the management of brain metastases,” lead study author Kamran A.
Ahmed, MD, a resident in the Department of Radiation Oncology at Moffitt, said
in an interview with OncLive. “We found that overall survival and local control
in this patient cohort was improved over historical controls, suggesting
nivolumab and radiation may have a synergistic effect in the management of
melanoma brain metastases.”

These findings are important, as there is a great need for improvement in the
management of patients with melanoma brain metastases, said Ahmed.
Historically, patients with melanoma brain metastases survive 4 to 5 months, on
average.

“About half of advanced melanoma patients will develop brain metastases,” said
Ahmed. “Improving outcomes in these metastatic melanoma patients who have the
worst prognosis is very important.”

In the study, all brain metastases were treated with stereotactic radiosurgery
(SRS) in a single session except for 12, who were treated with fractionated
stereotactic radiation therapy, 9 of whom were in the postoperative setting.

One patient experienced grade 2 headaches following SRS with symptomatic relief
with steroid treatment. No other treatment-related neurologic toxicities or
scalp reactions were reported.

Eight (11%) local brain metastases failures with a >20% increase in volume
were noted in the study. Of these lesions, hemorrhage was noted in 4 and edema
was noted in 7.

“We found nivolumab combined with either radiation treatment before, during, or
after was very well tolerated,” said Ahmed. “There were no neurotoxicity or
cutaneous side effects, which we would not expect with radiation treatment
alone. We know the 2 agents can be combined safely based on this study.”

The current standard of care for melanoma brain metastasis is focal radiation
treatment for patients with limited disease, and whole brain radiation for
patients with advanced disease. As nivolumab and other immunotherapies become
more commonly used in melanoma, it is important to understand how they will
work in conjunction with radiation, says Ahmed.

“Multiple systemic agents have proven to have a survival benefit in advanced
melanoma, and it is important to see how these therapies interact with
radiation treatment as well as surgery,” said Ahmed. “What we’ve seen here at
Moffitt is that immunotherapy and radiation treatment can be safely combined,
with improved local and distant brain control as well as overall survival in
patients with brain metastases.”

Following this retrospective analysis, there are plans to evaluate nivolumab
and radiation therapy in the prospective setting to better understand the
potential synergistic effects between the two.

“A lot of work needs to be done to see how we can improve outcomes in the
management of melanoma brain metastases, but what we’ve learned here is a good
start,” said Ahmed.

Wonder if this rattie was included in this retrospective. I had a brain met treated with one session of SRS in April 2010 and started Nivo at Moffitt in December of 2010....with one additional ????? lesion in my brain per the MRI on entry...(Here is the story of that conundrum: Melanoma Neverland)...that was no longer seen on MRI's after three months of treatment. As happy as I am that that was the case and that whoever these ratties may be, are are leading the way with the info produced here....isn't it strange that the ratties are NEVER told?????!!!! - c